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I use total intravenous anaesthesia for virtually all my anaesthetics and it is clear that this is one of the more environmentally friendly anaesthetic agents to use as it contributes to far fewer greenhouse gas emmisions than desflurane which is has the hightest greenhouse gas equivalence of the commonly used general anaesthetic agents available in Australia. There is a growing movement within the anaesthesia community to remove desflurane entirely from contemporary anaesthetic practice and I am fully in support of this goal. For more please see https://www.tra2sh.org/refuse-desflurane.

In one of the hospitals I work in there was another case of gelofusine anaphylaxis. It is not a particularly good as a colloid volume expander and has a long known about higher rate of anaphylaxis associated with its use. I don’t use it and i wonder why colleagues still do. This recent in Anaesthesia paper is timely and asks the same question.

There has been increasing realisation over the past several years of the potential harm associated with excess oxygen administered to adult patients and that we should be more considered in our use of oxygen therapy in acute care settings. Recent guidelines published in the BMJ “Oxygen therapy for acutely ill medical patients: a clinical practice guideline” highlight that saturations of 96% should be the upper maximum targeted and that oxygen therapy is not indicated when oxygen saturations are 93% or higher and probably should not be administered when saturations are 90-92%.

A nice little history of the premixing of gases for medical use including entonox by Tunstall in the BJA 1968.

In the review article blood pressure and the brain and cerebral autoregulation John Drummond provides a good overview of the science and evidence guiding appropriate blood pressure management during anaesthesia in both the supine and sitting positions. He makes the point that the lower limit of autoregulation in normotensive adults is a mean arterial pressure of not less than 70mmHg and that there is wide interindividual variation and that consideration for posture needs to be taken into account especially in the upright posture during anaesthesia.